Pulmonary actinomycosis is rare in children and is commonly confused with other chronic suppurative lung disease or with malignancy because of its non-specific clinical presentation. The diagnosis is dependent on either the characteristic histologic findings of sulfur granules or the isolation of actinomyces on culture. A long course of penicillin is the treatment of choice. There have been a few reports on children with primary pulmonary actinomycosis in recent 10 years, but coincident remote lower chest wall involvement has never been reported. We report here a 10-year-old immunocompetent girl presenting with chest pain and pulmonary infiltrate, who was found to have pulmonary actinomycosis with remote chest wall involvement. Computed tomography (CT) as an adjunct in diagnosis is also discussed.

Background: Gastric perforation among neonates is a rare but frequently fatal condition of uncertain etiology.The aim of this study was to review the clinical course of neonatal gastric perforation and to evaluate possible prognostic factors.Methods: We retrospectively analyzed the medical records of 15 patients with neonatal gastric perforation over a 19-year period.Another 97 patients described in the medical literature, for whom the gestational ages and birth weights were clearly stated, were also reviewed.Results: In our series, there were three girls and 12 boys, nine of whom were fullterm infants and six preterm infants.The most common initial manifestations were poor activity, abdominal distension, and respiratory distress.The overall mortality was 47% (7/15).Prematurity was the only statistically significant risk factor; 83% (5/6) of premature infants died compared with 22% (2/9) of term babies (p < 0.05).Combining our series with the patients reported in the literature, there were a total of 50 premature infants and 62 term infants.Gastric perforation occurred on postnatal days 2-7 and presented with nonspecific manifestations.The mortality was significantly higher in premature than in term infants (31/50, 62% vs. 16/62, 26%; p < 0.001).A trend towards higher mortality in infants with lower birth weights was observed (> 2500 g, 28%; 1501-2500 g, 52%; 1000-1500 g, 60%; < 1000 g, 100%).Infants with birth weights < 2500 g had a significantly higher mortality than infants with birth weights > 2500 g (32/58, 55% vs. 15/54, 28%; p < 0.05).Conclusion: Neonatal gastric perforation is associated with high mortality, particularly in premature infants.There is also a trend towards higher mortality in lowerbirth-weight infants.